The New York State Health Insurance Program (NYSHIP) offers the Opt-Out Program to CSEA, NYSCOPBA, PBANYS, PEF, and M/C employees. UUP employees are not currently eligible for this program.
This program allows eligible employees who have other employer-sponsored group health insurance to opt out of their NYSHIP coverage in exchange for an incentive payment. On an annual basis, the incentive payment is $1,000 for opting out of individual coverage or $3,000 for opting out of family coverage.
Eligibility Requirements
To qualify for the Opt-Out Program you must meet one of the following eligibility criteria:
For the purpose of the Opt-Out Program, other employer-sponsored group health insurance coverage is through employment other than with the State University of New York (SUNY). Therefore, if the other coverage is through a NYS employee or retiree, the employee is not eligible for the Opt-Out Program. However, coverage through another employer such as a municipality, school district or public benefit corporation qualifies as other coverage.
Electing to Opt Out
If you are currently enrolled in NYSHIP and wish to participate in the Opt-Out Program, you must elect to opt out during the annual Option Transfer Period. You must complete the Health Insurance Transaction Form (PS-404) and the Opt-Out Attestation Form (PS-409). If you enroll in the Program and you are eligible for dental and vision coverage, your eligibility for dental and vision coverage will not be affected.
You will be required to attest that you are covered by other employer-sponsored group health coverage and provide information regarding the person who carries that coverage, as well as the name of the other employer and other health plan. You will also be required to submit a copy of your health insurance card. You should check to see whether the other employer-sponsored plan will permit you to enroll as a dependent. You are responsible for making sure your other coverage is in effect during the period you are opting out of NYSHIP. Your NYSHIP coverage will terminate at the end of the plan year and the incentive payments will begin after January 1 (the new plan year).
If you are a new hire or newly-eligible employee who has other employer-sponsored group health insurance and wish to participate in the Opt-Out Program, you must make your election no later than the first date of your eligibility for NYSHIP benefits.
If you are newly eligible as a result of a change in bargaining unit, you may elect to participate in the program within 30 days of the effective date of the bargaining unit change.
If you are transferring from one State agency to another, you are not newly eligible unless you were previously working in a non-benefits eligible position or in a bargaining unit not eligible for the Opt-Out Program.
If you currently participate in the Opt-Out Program and wish to participate in the program for 2024, you do not need to take any action.
Incentive Payments
The annual incentive amount for opting out of NYSHIP coverage is $1,000 for Individual coverage or $3,000 for Family coverage. The incentive payments will be prorated and reimbursed through the employee’s biweekly paychecks throughout the year (payable only when an employee is on the payroll and meets the requirements to be eligible for the State to contribute to the cost of NYSHIP coverage.)
The incentive amount will be credited to the employee’s biweekly paycheck and will be treated as taxable income. The biweekly incentive amounts will be $38.47 for opting out of Individual coverage ($1,000/26 paychecks) or $115.39 for opting out of Family coverage ($3,000/26 paychecks).
Changes Affecting Opt-Out Program Eligibility
An employee loses eligibility for participation in the Opt-Out Program during any period when:
If an employee loses eligibility for the Opt-Out Program temporarily because of being off the payroll, experiencing a reduction of hours or being on leave, the employee will automatically resume participation in the Opt-Out Program for the remainder of that plan year upon regaining eligibility.
An employee receiving the incentive for opting out of Family coverage whose last dependent loses NYSHIP eligibility, will only be entitled to the individual incentive payment, effective on the date the dependent loses eligibility.
Reenrollment in NYSHIP
Employees who participate in the Opt-Out Program may reenroll in NYSHIP during the next annual Option Transfer Period. To reenroll in NYSHIP coverage any other time, employees must experience a qualifying event like a change in family status (e.g.; marriage, birth, death, or divorce) or loss in coverage. Employees must complete the Health Insurance Transaction Form (PS-404) and provide proof of the qualifying event within 30 days or any change in enrollment will be subject to NYSHIP’s late enrollment waiting period, which is five biweekly pay periods. You will not be eligible for NYSHIP coverage during the waiting period, and you cannot elect pre-tax health insurance deductions until the following year.
Retirement while in the Opt-Out Program
Participation in the Opt-Out Program is considered participation in NYSHIP for purposes of establishing eligibility for NYSHIP coverage in retirement. Retirees are not eligible for the Opt-Out Program, so participation terminates when the employee’s eligibility for NYSHIP coverage as an active employee ends.
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